Breast
Cancer Basics
What Is Breast
Cancer? Cells
in the body normally divide reproduce) only when new cells are needed.
Sometimes, cells in a part of the body grow and divide out of control,
which creates a mass of tissue called a tumor. If the cells that are
growing out of control are normal cells, the tumor is called benign
(not cancerous.) If however, the cells that are growing out of control
are abnormal and don't function like the body's normal cells, the
tumor is called malignant (cancerous).
Cancers are named
after the part of the body from which they originate. Breast cancer
originates in the breast tissue. Like other cancers, breast cancer
can invade and grow into the tissue surrounding the breast. It can
also travel to other parts of the body and form new tumors, a process
called metastasis.
What Causes Breast Cancer? We
do not know what causes breast cancer, although we do know that certain
risk factors may put you at higher risk of developing it. A risk factor
is anything that puts you at higher risk of developing a particular
disease. A person's age, genetic factors, personal health history
and diet all contribute to breast cancer risk.
Who Gets Breast
Cancer? Breast
cancer is the most common cancer among women other than skin cancer.
Breast cancer
is the second-leading cause of cancer death in women after lung cancer
-- and is the leading cause of cancer death among women ages 35 to
54. In 2001, 192,200 women will be diagnosed with breast cancer and
approximately 40,600 will die. Although these numbers may sound frightening,
research reveals that the mortality rate could decrease by 30% if
all women age 50 and older who need a mammogram had one.
Only 5-10% of
breast cancers occur in women with a clearly defined genetic predisposition
for the disease. The majority of breast cancer cases are "sporadic,"
meaning there is no direct family history of the disease. The risk
for developing breast cancer increases as a woman ages.
What Are The
Warning Signs Of Breast Cancer?
- Lump or thickening
in or near the breast or in the underarm that persists through the
menstrual cycle
- A mass or lump,
which may feel as small as a pea
- A change in
the size, shape or contour of the breast
- A blood-stained
or clear fluid discharge from the nipple
- A change in
the feel or appearance of the skin on the breast or nipple (dimpled,
puckered, scaly or inflamed)
- Redness of
the skin on the breast or nipple
- An area which
is distinctly different from any other area on either breast
- A marble-like
hardened area under the skin
These changes
may be found when performing monthly breast self-exams. By performing
breast self-exams, you can become familiar with the normal monthly
changes in your breasts.
Breast self-examination
should be performed at the same time each month, three to five days
after your menstrual period ends. If you have stopped menstruating,
perform the exam on the same day of each month.
What Are The
Types Of Breast Cancer? The
most common types of breast cancer are:
- Infiltrating
(invasive) ductal carcinoma. This cancer starts in the milk ducts
of the breast. Then it breaks through the wall of the duct and invades
the fatty tissue of the breast. This is the most common form of
breast cancer, accounting for 80% of cases.
- Ductal carcinoma
in situ is ductal carcinoma in its earliest stage (stage 0). In
situ refers to the fact that the cancer hasn't spread beyond its
point of origin. In this case, the disease is confined to the milk
ducts and has not invaded nearby breast tissue. If untreated, ductal
carcinoma in situ may become invasive cancer. It is almost always
curable.
- Infiltrating
(invasive) lobular carcinoma. This cancer begins in the lobules
of the breast where breast milk is produced, but has spread to surrounding
tissues or the rest of the body. It accounts for 10-15% of breast
cancers.
- Lobular carcinoma
in situ is cancer that is only in the lobules of the breast. It
isn't a true cancer, but serves as a marker for the increased risk
of developing breast cancer later, possibly in both breasts. Thus,
it is important for women with lobular carcinoma in situ to have
regular clinical breast exams and mammograms.
- Cancers can
also form in other parts of the breast but are more rare.
What Are The
Stages Of Breast Cancer? Early
stage or stage 0 breast cancer is when the disease is localized to
the breast and lymph nodes (carcinoma in situ).
Stage I breast
cancer: The cancer is smaller than 1 inch across and it hasn't spread
anywhere.
Stage II breast
cancer is one of the following: the tumor is less than an inch across
but has spread to the underarm lymph nodes (IIA); or the tumor is
between 1-2 inches (with or without spread to the lymph nodes); or
the tumor is larger than 2 inches and not has spread to the lymph
nodes under the arm (both IIB).
Advanced breast
cancer (metastatic) results after cancer cells spread to the lymph
nodes and to other parts of the body.
Stage III breast
cancer is also called locally advanced breast cancer. The tumor is
larger than 2 inches and has spread to the lymph nodes under the arm,
or a tumor that is any size with cancerous lymph nodes that adhere
to one another or surrounding tissue (IIIA).
Stage IIIB breast
cancer is a tumor of any size that has spread to the skin, chest wall
or internal mammary lymph nodes (located beneath the breast and inside
the chest).
Stage IV breast
cancer is defined as a tumor, regardless of size, that has spread
to places far away from the breast, such as bones, lungs or lymph
nodes.
How Is Breast
Cancer Diagnosed? During
your regular physical examination your doctor will take a careful
personal and family history and performing a breast examination and
possibly one or more other tests.
Breast Examination:
During the breast exam, the doctor will carefully feel the lump and
the tissue around it. Breast cancer usually feels different (in size,
texture and if it moves easily) than benign lumps.
Mammography: an
X-ray test of the breast can give important information about a breast
lump.
Digital mammography:
A new technique in which an X-ray image of the breast is recorded
into a computer rather than on a film. In January 2000, the FDA approved
a digital mammography system that may offer potential advantages over
the use of standard X-ray film. Study results have not shown that
digital images are more effective in finding cancer than X-ray film
images, but they may reduce your exposure to radiation.
Ultrasonography:
This test uses sound waves to detect the character of a breast lump
-- whether it is a fluid filled cyst (not cancerous) or a solid mass
(which may or may not be cancer). This may be performed along with
the mammogram.
Based on the results
of these tests, your doctor may or may not request a biopsy test to
get a sample of the breast mass cells or tissue. Biopsies are performed
using surgery or needles.
After the sample
is removed, it is sent to a lab for testing. A pathologist -- a doctor
who specializes in diagnosing abnormal tissue changes -- views the
sample under a microscope and looks for abnormal cell shapes or growth
patterns. When cancer is present, the pathologist can tell what kind
of cancer it is (ductal or lobular carcinoma) and whether it has spread
beyond the ducts or lobules (invasive).
Laboratory tests,
such as hormone receptor tests (estrogen and progesterone) can show
whether the hormones help the cancer to grow. If the test results
show that hormones help the cancer grow (a positive test), the cancer
is likely to respond to hormonal treatment. This therapy deprives
the cancer of the estrogen hormone.
Breast cancer
diagnosis and treatment are best accomplished by a team of experts
working together with the patient. Each patient needs to evaluate
the advantages and limitations of each type of treatment, and work
with her team of physicians to develop the best approach.
Other Diagnostic
Tests Other
methods being investigated but not yet available include:
- Scintimammography:
A technique in which radioactive contrast agents are injected into
a vein in the arm. An image of the breast is taken with a special
camera, which detects the radiation (gamma rays) emitted by the
dye. Tumor cells, which contain more blood vessels than benign tissue,
collect more of the dye and project a brighter image.
- Positron Emission
Tomography (PET) scanning: A technique that measures a signal from
injected radioactive tracers that migrate to the rapidly dividing
cells of cancer. The PET scanner picks up the signal and creates
an image.
- Magnetic Resonance
Imaging (MRI): A test that produces very clear pictures, or images,
of the human body without the use of X-rays. MRI uses a large magnet,
radio waves and a computer to produce these images.
- Scientists
are also exploring ways to detect breast cancer or markers of cancer
in the blood, urine and in fluid taken from the nipple.
How Is Breast
Cancer Treated? If
the tests find cancer, you and your doctor will develop a treatment
plan to eradicate the breast cancer, to reduce the chance of cancer
returning in the breast, as well as to reduce the chance of the cancer
traveling to a location outside of the breast. Treatment generally
follows within a few weeks after the diagnosis.
The type of treatment
recommended will depend on the size and location of the tumor in the
breast, the results of lab tests done on the cancer cells and the
stage or extent of the disease. Your doctor usually considers your
age and general health as well as your feelings about the treatment
options.
Breast cancer
treatments are local or systemic. Local treatments are used to remove,
destroy or control the cancer cells in a specific area, such as the
breast. Surgery and radiation treatment are local treatments. Systemic
treatments are used to destroy or control cancer cells all over the
body. Chemotherapy and hormone therapy are systemic treatments. A
patient may have just one form of treatment or a combination, depending
on her needs.
Surgery
Breast
conservation surgery involves removing the cancerous portion of the
breast and an area of normal tissue surrounding the cancer, while
striving to preserve the normal appearance of the breast. This procedure
has often been called a lumpectomy, a partial mastectomy or a quadrantectomy.
Some of the lymph nodes under the arm are also removed. Usually, six
to eight weeks of radiation therapy is then used to treat the remaining
breast tissue. Most women who have a small, early-stage tumor are
excellent candidates for this approach.
Mastectomy (removal
of the entire breast) is another option. The mastectomy procedures
performed today are not the same as the older radical mastectomies.
Radical mastectomies were extensive procedures that involved removing
the breast tissue, skin and chest-wall muscles. Today mastectomy procedures
do not ordinarily remove muscles and, for many women, mastectomies
are accompanied by either immediate or delayed breast reconstruction.
What Happens
After Treatment? Following
local breast cancer treatment, the treatment team will determine the
likelihood that the cancer will recur outside the breast. This team
usually includes a medical oncologist, a specialist trained in using
medicines to treat breast cancer. The medical oncologist, who works
with the surgeon, may advise the use of tamoxifen or possibly chemotherapy.
These treatments are used in addition to, but not in place of, local
breast cancer treatment with surgery and/or radiation therapy.
Does A Benign
Breast Condition Mean That I Have A Higher Risk Of Getting Breast
Cancer?
Benign breast
conditions rarely increase your risk of breast cancer. Some women
have biopsies that show a condition called hyperplasia (excessive
cell growth). This condition increases your risk only slightly.
When the biopsy
shows hyperplasia and abnormal cells, a condition called atypical
hyperplasia, your risk of breast cancer increases somewhat more. Atypical
hyperplasia occurs in about 5 percent of benign breast biopsies.
How Can I Protect
Myself From Breast Cancer? Follow
these three steps for early detection:
Get a mammogram.
The American Cancer Society recommends having a baseline mammogram
at age 35, and a screening mammogram every year after age 40. Mammograms
are an important part of your health history. If you go to another
healthcare provider, or move, take the film (mammogram) with you.
Examine your breasts
each month after age 20. You will become familiar with the contours
and feel of your breasts and will be more alert to changes.
Have your breast
examined by a healthcare provider at least once every three years
after age 20, and every year after age 40. Clinical breast exams can
detect lumps that may not be detected by mammogram.
May 2001, Medically
Reviewed by Charlotte E. Grayson, MD, WebMD.
Copyright ©2002
content, The Cleveland Clinic. The information provided by The Cleveland
Clinic is not intended to replace the medical advice of your doctor
or health-care provider. Please consult your health-care provider
for advice about a specific medical condition. For additional health
information, please contact the Health Information Center at The Cleveland
Clinic, (216) 444-3771 or toll-free (800) 223-2273, Ext. 43771.
